Introduction: Obesity is an increasing public health burden in the USA. According to the National Obesity Trends, about one-third adults in the USA are obese. What is worse, this trend keeps increasing during the past twenty years. Appalachian region has higher prevalence for obesity and diabetes comparing with other places in the USA. Body Mass Index (BMI), as an important measure for obesity, is useful for determining effective preventions for obesity. However, as the most common index for obesity, BMI is influenced by other variables such as smoking, alcohol and physical activity. A single indicator is not enough to measure the complicated factors which lead to obesity and so do interventions to prevent obesity. This study is aimed to study the influence of race and gender differences in the association between smoking and alcohol consumption and BMI. Methods: We obtained data from the Health Aging and Body Composition (Health ABC) Study. This sample consists of 1663 European American (EA) and 1139 African American (AA) individuals (1367 males and 1435 females). Phenotypes include age, BMI, smoking and alcohol drinking status. The SASv9.2 was used to perform the data analysis. Firstly, the Wilcoxon ranks test was used to compares the gender differences in continuous variables such as age and BMI while chi-square test was used to test gender differences for binary variables such as alcohol and smoking status. Then, multiple general linear model (GLM) was used to test the association of alcohol drinking and smoking behaviors with BMI. Results: For the whole sample, multiple GLM showed age (pConclusion: There are gender and race differences in the association between smoking behavior and BMI. This discovery helps us to tailor interventions for different subgroups. For the future prevention of obesity by controlling BMI, the factors of gender and race/ethnicity should be taken into account.

This review focuses on nicotine comorbidity in schizophrenia, and the insight into this problem provided by rodent models of schizophrenia. A particular focus is on age differences in the response to

Background: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. Objective: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Methods: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Results: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. Conclusion: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community’s environment, especially if older persons are involved. Scientific Significance: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

Background: The United States is currently experiencing an epidemic of opioid abuse. Individuals with opioid dependence may also have major depressive disorder (MDD) as a co-morbid state. MDD is one of the commonest mental health problems in the United States, affecting approximately 7% of the adult population. The relationship between opioid dependence and MDD and the factors that correlate with them have not been fully investigated. This study is designed to evaluate the prevalence of MDD and its associations with risk factors and health conditions such as age, race, sex, liver problems, anxiety, bipolar disorders, hypertension, heart diseases, neurologic damage, head injury and alcohol in opioid dependent patients. Method: The study population comprises of 1646 opioid dependent patients from the National Drug Abuse Treatment Trial Network (CTN) - CTN 0027. Baseline information on sex, age, race, liver disease, bipolar disorder, anxiety, neurologic damage, heart disease, hypertension, alcohol dependence, allergies, gastrointestinal problems and head injury were collected. Data analysis was done using univariate and multiple logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of MDD among patients with opioid dependence was 28.3% (22.8% for males and 39.5% for females). The prevalence initially increased with increasing age stratum but declined after age 50 years with the highest prevalence in the age 36 – 49years group. The multiple logistic regression analysis showed that MDD in opioid dependent patients was significantly associated with being female (OR =1.83, 95%CI = 1.32 -2.55; p = 0.003), liver disease (OR = 1.64, 95%CI = 1.15 - 2.34, p = 0.006), anxiety (OR = 6.12, 95%CI = 4.44 - 8.44, p

This study analyzed the associative properties of nicotine in a conditioned place preference (CPP) paradigm in adolescent rats neonatally treated with quinpirole (NQ) or saline (NS). NQ produces dopamine D2 receptor supersensitivity that persists throughout the animal's lifetime, and therefore has relevance towards schizophrenia. In two experiments, rats were ip administered quinpirole (1mg/kg) or saline from postnatal day (P)1–21. After an initial preference test at P42–43, animals were conditioned for eight consecutive days with saline or nicotine (0.6mg/kg free base) in Experiment 1 or saline or nicotine (1.8mg/kg free base) in Experiment 2. In addition, there were NQ and NS groups in each experiment given the antipsychotic haloperidol (0.05mg/kg) or clozapine (2.5mg/kg) before nicotine conditioning. A drug free post-conditioning test was administered at P52. At P53, the nucleus accumbens (NAc) was analyzed for glial cell-line derived neurotrophic factor (GDNF). Results revealed that NQ enhanced nicotine CPP, but blunted the aversive properties of nicotine. Haloperidol was more effective than clozapine at blocking nicotine CPP in Experiment 1, but neither antipsychotic affected nicotine conditioned place aversion in Experiment 2. NQ increased accumbal GDNF which was sensitized in NQ rats conditioned to nicotine in Experiment 1, but the aversive dose of nicotine reduced GDNF in NQ animals in Experiment 2. Both antipsychotics in combination with the aversive dose of nicotine decreased accumbal GDNF. In sum, increased D2 receptor sensitivity influenced the associative properties and GDNF response to nicotine which has implications towards pharmacological targets for smoking cessation in schizophrenia.

Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor involved in synaptic differentiation, growth, and maintenance. Increases in BDNF have been shown in substance abuse and decreases in BDNF have been shown in response to stress and major depressive disorder (MDD). We analyzed the effects of BDNF upregulation via lentivirus on Pavlovian conditioned approach (PCA), behavioral sensitization, and nicotine self-administration in rats. Lentiviral-mediated expression cassettes, with dual promoters to drive the BDNF gene and the reporter gene were constructed according to the manufacturer’s instruction and surgically injected into the nucleus accumbens (Nac), the primary brain area that mediates drug reward and reinforcement. Rats were allowed to recover for three weeks before behavioral testing commenced. All rats were trained to associate the presentation of a lever and illumination of a stimulus light with delivery of 20% sucrose in a Pavlovian conditioned approach (PCA) task. Head entries into the receptacle where sucrose was delivered (goal tracking) and lever pressing (sign tracking) during the conditioned stimulus (CS) were measured to determine if BDNF over-expression (BDNF+) altered approach to the sign or goal location. Rats in the BDNF+ group made more goal directed behaviors during the CS than sham group. There were no differences in sign tracking and no differences in basal activity. This pattern suggests that BDNF over-expression may increase reward-related learning in a manner specific to goal tracking. Three days after completion of the PCA task, all animals were habituated to a locomotor arena followed by nicotine behavioral sensitization, and were administered nicotine (ip, 0.5 mg/kg free base) or saline every second day for seven days. Results revealed that the BDNF+ group demonstrated enhanced sensitivity to the hypoactive response to nicotine. At day 7, BDNF+ animals demonstrated enhanced behavioral sensitization to nicotine as compared to all other groups, and Sham NIC animals demonstrated sensitization compared to Sham SAL controls. Thus, it appears increasing NAc BDNF expression enhances the behavioral response to nicotine. Animals were then surgically implanted with a jugular catheter and commenced nicotine self-administration. Interestingly, BDNF+ rats demonstrated reduced nicotine self-administration and motivation to obtain nicotine. Global changes in BDNF expression could be a mediating variable in endophenotypes that are more or less susceptible to drug-taking and substance dependence.

Drug poisoning due to overdose is a major health problem in Tennessee. In TN there has been an increase of 210% in accidental overdose deaths since 1999 to 2010. About 80% of drug poisonings in Tennessee were either accidental or self-inflicted. Also as indicated by the CDC in 2010 enough drugs were prescribed to medicate every American adult around-the-clock for one month and the vast amount of drugs increases the risk of misuse. Drug Take Back Events are a useful measure for reducing the number of prescription medications kept in the households. However, the extent to which these events have affected in the reduction of drug poisoning is not well known. The objective of this study was to investigate the relation between the total number of drugs collected at Take Back Events and emergency department admissions due to overdose in three Counties in Northeast TN. In partnership with Drug Enforcement Administration and local law enforcement, drop box donations for controlled substances (CS) were analyzed for Washington, Carter and Sullivan County, Tennessee, from 2009 to 2012. Data were obtained from Tennessee Department of Health on number of emergency department (ED) admissions due to overdose based on International Classification of Diseases (ICD)-9 codes occurred between 2009 and 2012 in the above-mentioned counties. Linear forecast trend-line method was used to evaluate associations between the amount of controlled substances collected via donation boxes and number of ED visits occurred during 2009-12. Furthermore Pearson’s correlation analyses were conducted to investigate relationship between drop box donations and ED admissions due to overdose. From 2009 – 2012 the ED visits shows a significant decrease as the amount of drugs collected increases for Washington and Carter County. Also a negative correlation is seen between the ED visit and drugs collection for Washington and Carter County with R2 values of -0.96 and -0.90 respectively. However the same is not true for Sullivan County as the trend was not inversely proportional and also the correlation between ED visits and gathered drugs is low with R2 value of -0.562. These results quantify the potential impact of drug take back events on reduction in drug poisoning due to overdose in Northeast Tennessee. Further study is required to examine the effect of the events on the epidemic of prescription drug abuse and misuse.

The US Food and Drug Administration (FDA) is encouraging the innovation of long-acting opioid formulations that are manipulation-resistant. The purpose of this commentary is to assess the benefits and limitations of abuse-deterrent opioid formulations (ADFs) and discuss their role in mitigating the current opioid epidemic. ADFs have been created with chemical properties that make it difficult for people who non-medically use prescription drugs to crush and dissolve opioid tablets, as well as by combining opioids with antagonists such as naloxone or naltrexone, which are released only when the dosage form has been manipulated or the drug is taken by a non-intended route. Despite these and other technologies, consensus regarding the effectiveness of these formulations in preventing non-medical use is lacking given the difficulty in obtaining post-marketing data. Researchers also question if the creation of abuse-deterrent drugs will have a positive effect on those struggling with a severe opioid-use disorder, fearing that current opioid users will simply find a new – perhaps more dangerous – drug of choice. Abuse-deterrent opioids are still opioids, and although they may make manipulation more difficult than non-ADF formulations, they are not “abuse proof.” The introduction of ADFs could provide a false sense of security among prescribers and dispensers, and we fear that ADFs may have a minimal impact on non-medical use of prescription opioids. Further epidemiological studies will be required to determine the large-scale impact of abuse-deterrent opioids in preventing opioid use disorder and its downstream consequences.

Background: The misuse and addiction to opioids are one of the major health and social problem that is associated with an increase in morbidity and mortality. Both Buprenorphine (BUP) and Methadone (MET) are FDA-approved treatments for opioid dependence. This longitudinal study is to determine the effects of BUP and MET on hypertension in patients with opioid dependence using a Generalized Estimating Equation(GEE) Model. Methods: The data is from National Drug Abuse Treatment Clinical TrialsNetwork (CTN) protocol CTN-0027. This is a randomized study of 1,934 opioid dependence participants seeking treatment that followed for up to 32 weeks. A total of1,284 males and 631 females participated at the Baseline (visit1) of the study. At the endof 32 weeks (10 visits), 499 males and 243 female patients completed the study. Blood pressure of all the patients was checked at every visit beginning visit 1 to visit 10. For this analysis, the dependent variable was hypertension which was defined as having asystolic blood pressure higher than 140 mmHg and/or a diastolic blood pressure higher than 90 mmHg. These participants were randomly assigned to receive BUP (n= 740) or MET (n= 529). The GEE model with exchangeable correlation was used to determine the efficacy of both the drugs on hypertension. The analysis was performed using PROCGENMOD in SAS 9.4. Results: Time increased the odds of hypertension (adjusted odds ratio (aOR): 1.04, 95% confidence interval (CI): 1.02-1.06, pConclusion: Findings suggest that BUP had a slightly less chance of causing hypertension among patients with opioid dependence comparing with MET controlling for other risk factors, but neither one of Page 54 2017 Appalachian Student Research Forum them had any significant effect on hypertension among patients with opioid dependence. Further analysis will be essential to detect gender x treatment interaction.

Objectives: Explain ideas to achieve meaningful, synergistic partnerships in combating the opioid crisis by leveraging unique areas of healthcare expertise (i.e., medical, payer, pharmacy) in collaboration with other key healthcare and policy experts. Describe innovative, results-driven solutions in development or in the marketplace to address opioid prescribing practices from the unique perspective of providers, pharmacists, health plans, patients and caregivers. Learn about the system breakdowns from patient and family member perspectives. Share possibilities for better integrating the voice and role of individuals living with addiction and caregivers into important solutions combating the opioid crisis. Identify the greatest, most near-term opportunities for improvements or system-wide changes, generally and for PQA.